2027 CPT Manual Preview: New Surgical Implant Codes for Knee Pain, Heart Failure, Diaphragmatic Hernia Repair, and Pharyngeal Tumor Excision

The 2027 CPT code set is shaping up to bring some of the most substantial surgical coding changes coders have seen in a few years. CMS previewed a long list of upcoming additions in the proposed 2027 Medicare Physician Fee Schedule, released July 14, 2026, covering everything from knee implants to cardiac contractility devices to pharyngeal tumor removal.

A quick but important caveat before diving in: none of the actual CPT codes shown below are final. CMS is required to publish something before the AMA releases its printed manual, so the agency uses placeholder “dummy” numbers (things like 27X05 or 33X01) to describe the new procedures. The real five-digit codes won’t be confirmed until the 2027 CPT code book is officially released later this year. 

Here’s a section-by-section breakdown of what’s coming next year , you’d find it in the CPT manual itself.

Integumentary System

The current lineup of skin cell suspension autograft codes (15011–15018) is being retired. In their place, CMS is proposing four new codes that report much larger graft areas — 100 square centimeters instead of the current 25 — and that are selected based on the body region treated rather than a flat size threshold.

For example, a new code (shown as 15X19) will describe a skin cell suspension autograft to the trunk, arms, and/or legs for the first 100 sq cm or less (or 1% of body surface area in infants and children). An add-on code, 15X20, will cover each additional 100 sq cm or fraction thereof. This will be a  meaningful shift for burn and wound-care coders, since it changes both the unit of measurement & how add-on quantities are calculated.

Musculoskeletal System

Several new procedures are landing here, and a few existing codes are getting clarifying language:

• Percutaneous fiducial marker placement: Two new codes will report intraosseous localization marker placement — one for the first target site (209X1) and an add-on for each additional site (209X2).
• Open cryoablation for bone tumors: A new code, 209XX, describes cryoablation therapy for bone tumors, including any adjacent soft tissue involved through tumor extension.
• Spinal osteotomy clarification: The four existing spinal osteotomy codes (22210, 22212, 22214, 22216) are being revised — not replaced — to make clear that complete resection of the interspinous ligament and the entire ligamentum flavum (both laminar and subarticular portions) is already bundled into these codes when performed for deformity correction through spinal realignment.
• Medial knee extra-articular shock absorber: A new code, 27X05, reports implantation of this device along with the fluoroscopic guidance used to place it — something coders working on knee pain and orthopedic implant claims will want to flag early.
• Acellular scaffold implants for osteochondral knee lesions: A new Category I code, 27XX8, replaces Category III code 0737T for the open technique. Separately, three new Category III codes (1092T–1094T) already debuted in the July 2026 update to cover both open and arthroscopic hyaluronan-based scaffold implants — those take effect January 1, 2027, alongside the rest of this update. Coders who track Category III/emerging technology code activity should note that knee cartilage restoration procedures are becoming a fast-moving area of the code set. Anyone coding arthroscopic knee surgery regularly should keep an eye on how these new scaffold codes interact with existing arthroscopy codes.

Cardiovascular System

This is one of the heaviest-hit sections in the proposal, largely because of cardiac contractility modulation (CCM) devices.

• CCM system codes: Eleven new Category I codes (33X01–33X11) will replace the current Category III codes (0408T–0416T and 0915T–0925T) for insertion, removal, revision, and replacement of a permanent CCM system. CCM devices deliver electrical impulses to strengthen cardiac muscle contraction in patients with symptomatic heart failure. Four companion codes in the Medicine chapter (93X01–93X04) will report CCM device interrogation and programming.
• Open left heart ventricular assist device (LVAD) codes: Three new codes (33X12–33X15) describe open insertion and removal of a left heart VAD. This fills a gap — the existing VAD codes (33990–33993) only cover percutaneous approaches.
• Transcatheter tricuspid valve replacement: A single new code, 33X50, replaces Category III code 0646T.
• Transcatheter tricuspid valve edge-to-edge repair: Two new codes, 33X51 (initial clip) and 33X52 (each additional clip, same session), will report this increasingly common structural heart procedure.

Hemic and Lymphatic Systems

Two new codes, 38X03 and 38X04, will report microvascular anastomosis connecting a single vein opening to any number of lymphatic vessels — a lymphedema treatment that reroutes blocked lymph flow into the venous system.

Mediastinum and Diaphragm

Nine new codes cover diaphragmatic hernia repair using several different surgical approaches. One example is 39X12, which reports thoracoscopic repair of a nontraumatic diaphragmatic hernia (Bochdalek or Morgagni type) in patients other than neonates. Two additional codes, 39XX1 and 39XX2, report division of the median arcuate ligament with celiac trunk release, including ganglionectomy when it’s performed.

Gastrointestinal System

• Transoral pharyngeal tumor removal: Two new codes, 42XX1 and 42XX2, describe transoral removal of an oropharyngeal and/or pharyngeal neoplasm performed under magnification with robotic assistance.
• Congenital duodenal obstruction repair: New open (44XX1) and laparoscopic (44XX2) codes will report duodenoduodenostomy or duodenojejunostomy for this condition.
• Pancreatic tumor ablation: A new open code, 48XXX, reports ablation combined with irreversible electroporation of pancreatic tumors — a technique worth flagging for coders who work pancreatic cancer surgical cases.
• Endoscopic submucosal dissection (ESD): Two new codes will separately report ESD of the upper GI tract (4XX01) and lower GI tract (4XX02) — a welcome addition for coders currently working around this technique with unlisted or analogous codes in colonoscopy and endoscopic coding.

Male Genital System

A single new code, 5XX14, will report transrectal or transperineal prostate biopsy, consolidating what has historically required separate code selection based on approach.

Radiology

Three new codes will report magnetic resonance angiography (MRA) of the head and neck: without contrast (70XX4), with contrast (70XX5), and without contrast followed by contrast administration (70XX6). This gives radiology coders a cleaner, more specific set of options than what’s currently available for head and neck MRA studies.

Medicine Section

The Medicine chapter sees updates across several subsections:

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• Biofeedback: A new add-on code, 90X03, reports biofeedback training by any modality (EMG, EEG, ECG, etc.) for each additional 15 minutes beyond the base service.
• Speech-language pathology: Code 92507 is being deleted entirely and replaced with ten more specific codes covering fluency disorders, speech sound production disorders, language comprehension and expression disorders, and voice/upper airway dysfunction or resonance disorders. This is a significant restructuring for coders who bill speech therapy services regularly, since a single general code is being split into diagnosis-specific options.
• Vestibular testing: Two new codes each will report video head impulse testing and rotational vestibular assessment using sinusoidal harmonic acceleration testing.
• Transcatheter drug delivery: Two new codes, 9XX04 and 9XX07, report percutaneous transcatheter delivery of therapeutic drugs via intracoronary drug-delivery balloon to a single major artery and/or its branches.
• Unattended sleep studies: The current codes (95800, 95801, 95806) are being deleted and replaced by six new codes (95X18–95X23) that allow coders to distinguish between low, moderate, and high complexity unattended studies — a more granular approach than what’s used in current sleep study coding.
• Autonomic nervous system testing: Six new codes (95XX4–95XX9) will report tilt table testing, sudomotor testing, and combined autonomic function testing procedures.
• Lactation care: Two new time-based codes, 978XX and 978X1, report lactation care directed by a physician or other qualified healthcare professional.
• Adaptive behavior services: Two Category III codes (0362T and 0373T) are being deleted, eight existing Category I behavior codes (97151–97158) are being revised, and six new Category I codes (97X1X–97X6X) are being added. According to CMS, the goal is to better define appropriate time increments, close reporting gaps, and clarify how technician versus physician/qualified health professional time — both face-to-face and non-face-to-face — should be reported.

What Coders Should Do Now

Since none of these codes are final, there’s no immediate billing action to take. But this is a good moment to:

• Flag any patients or scheduled procedures in your specialty area (particularly cardiology, orthopedics, and GI) that might be affected once these codes go live January 1, 2027.
• Start reviewing current documentation templates for CCM device procedures, diaphragmatic hernia repairs, and pharyngeal tumor excisions, since the new code descriptors will likely require more granular operative note detail than the codes they replace.
• Watch for the finalized 2027 Medicare Physician Fee Schedule and the printed CPT manual release for the actual five-digit codes.

For a broader look at everything CMS has proposed for 2027 — including new HCPCS and ICD-10-CM changes — see the 2027 code set overview and the ICD-10-CM 2027 updates guide.